author ten years ago. The woman suffers from general nervous condition and local nervous symptoms. The general nervous system is weak, her vital manifestations are lessened and bodily activity is limited. She is easily tired, the head aches, and the patient is irritable. Vasomotor disturbances arise as flashes (heat center), flushed (circulatory center), and sweating (sweat center). Local nervous symptoms arise, as backache, pain in the sacrum and legs, and abdominal pain, roaring in the ears, flecks before the eyes, cardiac palpation, vomiting and other pains, such as excessive peristalsis and active sphincter, as well as excessive secretions from the mucosa. Generally all nervous symptoms or regular life are interrupted during menstruation, hence quiet and rest should be taken during flow. Chorea is worst at the monthly.

During menstruation many functions are disturbed, made excessively deficient or disproportionate, as in the tractus intestinalis (diarrhea, vomiting), in the skin (sweating), and in the kidneys (disproportionate secretion). Various neuralgias arise, recurrent headaches, and even menstrual psychosis, hysterical stigmata are intensified at the monthly.

THE CRISIS OF GESTATION.

The third sexual crisis, gestation, does not present so many disturbed nervous symptoms as the menstrual crisis. Its circle of nervous manifestations is more circumscribed and perhaps less intense. With its entrance gradually increased mental irritation may arise. The patellar reflexes are increased. It is said the watery part of the blood is increased and the hemoglobin is lessened. Change of blood nourishment would account for brain and mental changes. The disturbance of gestation is reflex through growth of the uterus irritating various nerve tracts. The thyroid gland increases, the breasts enlarge, and the discoloration of the nipple ensues. The genital and other neuralgias occur, from uterine pressure and stretching. Toothache, intercostal neuralgia and mastodynia appear with increasing size of the uterus. Pain appears along with the outline of the great sciatic and other nerves under trauma. Pain may arise from the shifting, loose sacro

iliac joint. Noticeable changes in the special sense organs occur. The eyes may be disturbed, the ears experience roaring. The most prominent changes occur in the taste, which may be anesthetic or hyperesthetic. Neuritis gravidium may exist.

It is a slow, continuous affection of the peripheral nerves, attacking chiefly the lower extremities. It is perhaps a traumatic neuritis. The nausea and vomiting of pregnancy is due chiefly to uterine contraction due to stretching or irritation of the uterus. Some vomiting, however, is undoubtedly due to hyperesthesia of the gastric mucosa. Emesis gravidarum is perhaps present in seventy-five per cent of all cases in primipara.

Gestation disposes to chorea. Rarely psychosis arises. Mental disturbances in delivery are due to the effects of pain, abdominal pressure and blood changes on the brain. For example, occasionally the head passing the brim of the pelvis traumatizes the obturator nerve so that I have observed the patient become almost unmanageable with pain. The patient frequently becomes wild with pain when the head passes and dilates the vulva. She acts and talks unreasonably from traumatic pain.

THE CRISIS OF PUERPERIUM.

The puerperium is the fourth sexual crisis of woman, with quite a definite circumscribed cycle. There is the puerperal paralysis, compression or traumatic paralysis of the lower extremities from trauma of the sacral plexus and obturator nerve as it passes through the pelvis. This paralysis arises from contracted pelvis or long continued labor, or by pressure of the forceps during delivery.

Inflammatory infectious paralysis may arise after parturition from infectious processes attacking the pelvic nerves. The process may be localized in the pelvis or spread by thrombi, which, breaking up, become emboli. The neuritis puerperalis (Moebius) runs its course as a multiple neuritis. It arises in the last half of gestation, or follows after an apparently normal birth. It may attack not only the pelvic, but also the cranial nerves, especially the optic.

THE CRISIS OF THE MENOPAUSE.

The menopause is the fifth sexual crisis of woman. The menopause manifests more nervous struggles than does the first appearance of menstruation. The nervous disturbances of the menopause are profound and characteristic. The chief evidences are disturbances of the circulatory center (flushes), disturbances in the heat center (flashes), and disturbances of the sweating (perspiratory) center. The menopause ends slowly-covering a period of about two and onehalf years. The climacterium presents

a distinct chain of nervous symptoms, neuroses which attack women previously nervous, as well as those who previous to this time had always enjoyed the best of health. The climacterium neurosis mostly first appears as physical manifestation. There is a preliminary period of excitation, or, more seldom, a depression, the woman becoming notably irritable. Some show a lessening of life energy. Hyperesthesia and anesthesia arise. The patient becomes sensitive to light, sound and smell. Taste is indolent. In general, the sexual power is not disturbed, as she is in the wrong age. Yet many women become pathologically erotic during the menopause. The menopause disturbs the whole nervous system, because the genitals are well supplied with nerves, and when the hypogastric plexus degenerates it will not transmit orders from the abdominal brain, so that their pent-up forces must go pell-mell over the nerve strands, disturbing circulatory, caloric and periphery centers, as well as disordering peristalsis and the secretions of the viscera. Dizziness is a common symptom. Roaring in the ears, disturbed eye symptoms, flashes, flushes, sweats and prickling and painful sensations arise. The

painful sensation lies chiefly in the legs and in the sacrum. Much fear exists from numerous heat palpations. The skin has pigmentary deposits in it, especially in the face and on the dorsum of the hands. Muscular weakness exists. Pruritis vulvæ exists frequently. The neurotic symptoms of the menopause simulate neurasthenia and hysteria.

Psychosis frequently enters the menopause. It is a disease of itself. The psychosis is frequently associated with anxiety, anxious affectations, with hallucinations and disturbed special sense.

The married menopautic woman suffers the least, the widow next, while the unmarried suffers the most from the psychosis of the menopause. In general, the menopause begins with a certain psychosis, excitation-depression, mania, melancholia.

It ends in general and local nerve disturbances, as well as circulatory, caloric and secretory disturbances. Abnormal sensation is almost a constant factor. Dis turbed sensations in the genitals are frequent, such as pressure, dragging and burning. The tractus intestinalis presents many irregular symptoms, as nausea, vomiting, excessive peristalsis, disproportionate secretions. The liver and pancreas may secrete abnormally, and constipation or diarrhea may arise.

Erotic delirium may prevail, the woman often accusing the husband of being untrue to her.

The general prognosis of psychosis of the menopause is not good. If recovery takes place, the trouble may recur. Many more remain ill than get well.

THE PHASE OF SENILITY.

Life becomes sexless. The once dominant sexual instinct is forever waning mentally, and fading physically; no passion or blood waves stir the subject. The organ whose function superimposed on adult life for a limited period has retired from the scene of activity. The genitals atrophy and shrink and disappear, and the labia become flat and pendulous. The tortuous segment of the utero-ovarian vascular circle loses its spiral state, it becomes straightened out, atrophic, with calcinous salts deposited in its walls.

It becomes the limited blood supply of fetal and childhood life. The uterooviducal muscularis disappears, and replaced by connective tissue. The thyroid gland atrophies, the hair lessens and loses its gloss, the face may assume a rudimentary beard growth, the utricular glands shrink, become cystic or gradually become remnants, the ovaries atrophy like peach stones, the vulva becomes contracted, and the vagina loses its contractility and rugæ, the external and internal genitals have returned to the state of fetal and childhood life. It is twice a girl and once a woman.

Mentally and

physically the phase of senility, and that of the fetal and childhood life are identical. The breasts atrophy and shrink, the body loses its round, plump form. Function and structure fade with advancing senility, whence the woman becomes a neutral sexyal individual.

[Written for the MEDICAL BRIEF.] Crustalactea.

BY THOS. A. E. EVANS, M. D., B. S., Farmers, Ky.

R. C. B., Texas, in November BRIEF, writes for information in regard to crustalactea. There are others who may be able to tell him more, but they have, as yet, failed to respond. Had the doctor given his name in full, I could have written him.

Crustalactea is not a primitive word, but a derivative word. If correctly written, it is crusta lactea, meaning milk crust, a form of eczema which is found with infants, and sometimes called infantile eczema or tetter (by the old women). To properly diagnose, the reader must bear in mind the many different forms of

eczema.

Crustalactea is always, when found, in nursing infants, and may first appear in the form of any of the varieties of eczema, and nearly always begins with erythema, running through all the primary forms, making marked secondary changes. The eruption may be mild, or may be severe, generally involving the head and face, but may involve the whole

body, or only a portion. I have never seen a case where the body was the seat of the disease, nor have I ever seen a case where the whole body was involved.

If the acute variety is not properly treated, it may subside into the chronic form of eczema, and remain the same for years.

The local variety causes the little one to scratch intensely, which causes the disease to increase. The affection first appears with variously sized reddened patches, with some papulation, more or less swelling, heat and itching, and by scratching the reddened surface is increased, raises, pours out a serum, which dries into scales and crust, which may, in turn, be torn off in the vain effort to obtain relief. Pus is rapidly poured out, which desiccates into thick, yellow and yellowish-brown scales, which are considerably elevated, each scale covering the entire inflamed surface, which I have seen as large as a fifty-cent piece, adhering very closely and tightly beneath the pustules, which are raw and exuding. The irritation may become intense, causing the child to suffer agony. The desire to scratch will continue, sleep seems out of the question, the little one only dozing for a short time to awake with renewed efforts to allay the itching. Here secondary trouble may set up, the child losing flesh, becomes thin, pale, refuses food, yields up the ghost.

The cause of this affliction is various, which I will not here undertake to describe. My aim in this paper is to try to plainly define crustalactea as I have met with it. The Doctor will know the treatment by the many varieties of eczema, so I will not give my treatment unless requested.

Intense Rheumatic Pains. Chev. Dr. Giacomo Caggesi, Naples, Italy, reports Bromidia wonderfully efficacious in relieving severe rheumatic pains of a chronic nature in a patient who had tried electricity, hydropathy, and a host of pharmaceutical remedies, without success. The pains finally disappeared altogether under the use of Bromidia.